So Jung Lee, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401417223 Issued in VA

Practice address

13880 Braddock Rd Ste 109
Centreville, VA 20121-2460

Phone

(703) 830-9990

NPI assigned

Jun 3, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Herndon Modern Dentistry, PC

  • Dentist
  • Reston, VA
  • NPI 1417587312
  NPD (past)
• John a Hudec Cleveland Dental Health Center Inc

  • General Practice Dentistry
  • Cleveland, OH
  • NPI 1891727558
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1821612904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9450 FAIRFAX BLVD APT 1504",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312422",
            "telephone_number": "703-969-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13880 BRADDOCK RD STE 109",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212460",
            "telephone_number": "703-830-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SO JUNG",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.026164",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angella Lee
• Benjamin K Lee, D.M.D.
• Lisa Jinyoung Lee, MS
• Michelle Lee, PHARMD
• Monica Lee
• Sora Lee, L.AC
• Legacy Smiles Group Dba MC Orthodontics PLLC
• Leisure Homecare LLC
• Frederick F Lennon, M.D.
• Let'S Smile of Centreville, PLLC

• General Practice Dentistry in Centreville, VA
• Providers in Centreville, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.